Anaesthetics, infants, and neurodevelopment: case closed?

Exposure of young animals, including non-human primates, to all anaesthetic and many sedative agents used in current clinical practice consistently produces neural injury.1,2 Findings of initial studies showed accelerated apoptosis, and later investigations have suggested several other potential mechanisms of injury. This injury is associated with later impairment of learning and memory.3 If these findings are also relevant to children, there might be profound consequences for anaesthetic care.4 However, up to now, all evidence in humans has been provided by observational studies, which have inherent limitations, especially the potential confounding effects of the conditions that necessitate exposure to anaesthesia.